Challenges in Diagnosing Necrotizing Sarcoid Granulomatosis: The First Case Reported From Indonesia

Singh, Gurmeet and Karsono, Ramadhan and Sjamsoe, Soedarman and Triono, Muhammad Rizki and Nora, Rina La Distia and Felicia, Devi and Gultom, Fajar Lamhot and Ruslim, Daniel and Sejati, Arif and Gunarsa, Ralph Girson and Pitoyo, Ceva Wicaksono and Rumende, Cleopas Martin (2025) Challenges in Diagnosing Necrotizing Sarcoid Granulomatosis: The First Case Reported From Indonesia. Case Reports in Medicine, 2025 (1). pp. 1-6. ISSN 1687 9635

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Abstract

Necrotizing sarcoid granulomatosis (NSG) is a rare disease characterized by granulomatous and necrotic features as well as vasculitis, and it primarily affects the lungs, with occasional extrapulmonary manifestations. The first documented case was in Jakarta, Indonesia. A 71-year-old male presented with prolonged fever, a neck mass, and multiple mediastinal lymphadenopathy. The disease was initially suspected as lung tuberculosis, but a surgical biopsy of the left thyroid lobe confirmed the NSG pattern. Treatment with oral prednisolone led to positive outcomes, as evidenced by radiological improvement at the 3-month follow-up. This case report aims to emphasize the challenges and the importance of clinician awareness in diagnosing NSG.

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